Clone of 2025 KWN Regular Individual Member

2026 KWN Regular Individual Member

To register as a Kenosha Women's Network member, please complete all questions.
Name

First NameLast Name
Name of Business
Title/Occupation
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
E-mail
example@example.com
KWN newsletter, notices of upcoming events, and other important information will be communicated by email.
Phone Number
Format: (000) 000-0000.
Phone number is (please choose one):
Website
Second Business (if applicable)
How did you find out about KWN?
Get Involved! Check all areas of interest!

Other
Signature
Signature Date

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
By completing and signing this form, you are agreeing to let KWN use your name/and or picture on marketing and promotional items to include, but not limited to, flyers, posters, social media pages, ads, emails, etc.

1 Year Membership

When paying from January through March.

$100.00

9 Month Membership

When paying from April through June.

$80.00

6 Month Membership

When paying from July through September.

$55.00

3 Month Membership

When paying from October through December.

$30.00

Credit Card

Apple Pay

Google Pay

Cash App Pay

2026 KWN Regular Individual Member